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Between 1978 and 1987, 587 cases of abdominal aortic aneurysm were operated on in the Vascular Unit of the Royal Infirmary of Edinburgh. Over this ten-year period there was a dramatic increase in the number of patients treated. Rupture had occurred in 278 patients. Of the 309 patients with non-ruptured aneurysm 175 were asymptomatic, 84 were symptomatic and 50 were acutely symptomatic. Two hundred and fifty-nine patients underwent elective operation and the 50 acutely symptomatic patients were operated on as emergencies. The overall mortality for the non-ruptured series was 2.9 per cent. The mortality in patients undergoing elective surgery was 1.9 per cent (1.1 per cent in asymptomatic and 3.6 per cent in symptomatic patients) and 4.0 per cent for patients undergoing emergency surgery.

Between 1974 and 1984, 174 patients with ruptured abdominal aneurysms have been treated by three vascular surgeons. The 11-year period showed a dramatic increase in the number of patients presenting with ruptured aneurysms. The overall operative survival, including patients who died before a graft could be inserted, was 67 per cent with improvement from 60 per cent in the first half of the period to 69 per cent in the second. The overall survival rate for the 162 who had a completed graft was 72 per cent. Reference to data from the Lothian area surgical audit showed that there has been a transfer of responsibility from general to vascular surgeons with an increase in the proportion of patients treated by operation. Concentration of care within a single specialized unit appears to have had a favourable effect on survival.

Surgical audit data for two 5-year periods (1974-78 and 1983-87) have been compared in a Health Board Area to assess the impact of centralization of emergency vascular services on the treatment of the acutely ischaemic lower limb. Patient populations in each period were comparable. Mortality rates remained constant in both periods at approximately 30 per cent. A significant improvement in overall limb salvage was observed (from 54 to 67 per cent, P less than 0.05). Limb salvage in survivors was improved from 80 to 95 per cent (P less than 0.001) and was paralleled by an increase in the number of reconstructive vascular procedures performed. We concluded that the centralization of emergency vascular services has not led to a reduced risk of mortality but has been associated with improved limb salvage.